Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5716 | OR |
NPI | 1003062969 |
---|---|
Provider Name | Matthew Joseph Kirchoff |
First Address | Tigard, OR 97224-7736 |
Second Address | Bend, OR 97701-4283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 09/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01820096 | RR MEDICARE (01) | OR |